Healthcare Provider Details

I. General information

NPI: 1619279411
Provider Name (Legal Business Name): PRECISION ORTHOTICS & PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR STE I58
LAS VEGAS NV
89106-4838
US

IV. Provider business mailing address

501 S RANCHO DR STE I58
LAS VEGAS NV
89106-4838
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-5502
  • Fax:
Mailing address:
  • Phone: 702-293-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1003167500
License Number StateNV

VIII. Authorized Official

Name: MR. JIMMY COLSON
Title or Position: C.E.O
Credential: C.O
Phone: 702-743-5179